Provider Demographics
NPI:1740228568
Name:SHARPE, LESLIE M (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4003
Mailing Address - Country:US
Mailing Address - Phone:215-357-4670
Mailing Address - Fax:215-357-4670
Practice Address - Street 1:696 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4003
Practice Address - Country:US
Practice Address - Phone:215-357-4670
Practice Address - Fax:215-357-4670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2449207P00000X
PAMD427697207P00000X
TXP9727207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101489033Medicaid